- As promised last month, the men now get their turn with the hormone connection. The timing seems fitting with the recent media blitz re the release of Androgel, by a Pharmaceutical company calling it the first testosterone gel available. (What is that Testosterone Gel we Dr's who use compounding pharmacies have been prescribing all these years??).
- So here we go with:
- Men may experience periandropause & andropause just as women may go through perimenopause & menopause. This has only recently received the attention it deserves as men were apparently thought to be invulnerable to this aspect of the aging process. Androgen deficiency is commonly over looked & under treated.
- Testosterone is produced by Leydig cells in the testes. Small amounts are produced in the adrenal glands & ovaries... From age 20, the Leydig cells start decreasing. By age 35-40, there is approximately a 15% decline in Test. & a 50% decline in spermatogenesis. The decline is progressive & gradual over years, being less abrupt than in women. Beside decreased functioning of the Test, producing cells, there may be less production because of declining stimulation from hormones in the brain which encourage Test. formation. A substance in the blood called sex binding globulin may also increase & bind the hormones making them less active. With age, there is also a progressive resistance of target cells to the androgens.
- As with women, some men will suffer significant hormone declines with concomitant symptoms, while others seem to have no problem. Women also have difficulties from decreased Test., but that is addressed in last months' newsletter, which is now posted on the web site.
- Stress contributes significantly to Test. depletion. Acute stress temporarily decreases Test. by 60-70%. Chronic stress depletes Test. which then remains at depleted levels. Vasectomy can prematurely promote Test. deficiency. Toxins can impair Test production, with the estrogenic chemicals in our environment being a major factor.
- Good nutrition improves testicular function. Malnutrition, low protein, low cholesterol , or low general food intake decrease Test. production. High amounts of vegetable oil, saturated fat, protein, Vitamins A, E & B Complex help increase Test. production.
- Testosterone release is augmented by low testosterone or estrogen levels (up to a point), by the hormones FSH, LH, LRH, ACTH, MELATONIN & increased blood flow to the testes. Release in inhibited by Cortisol, high blood testosterone, & psychological effects.
WHAT DOES TESTOSTERONE DO?
- Testosterone is an important hormone for muscles. It:
- Maintains heart muscle protein synthesis ( & can be helpful with cardiomyopathy)
- Promotes coronary artery dilation, & therefore improves blood flow to the heart ( thus helpful with coronary insufficiency).
- Stimulates the production of red blood cells.
- Maintains a positive balance of Calcium, Phosphorus, Potassium, & Nitrogen (thus helping with bone & other tissue health).
- Increases the incorporation of amino acids & protein synthesis in muscles, liver, & kidneys, thus stimulating their growth & metabolism.
- Increases the breakdown of fat, while decreasing the breakdown of amino acids.
- Increases basal metabolism.
- Regulates oxidation.
- Increases creatine storage (a muscle & digestive tonic) & decreases loss of creatine in the urine.
- Effects new RNA synthesis & the DNA template in the nucleus.
- Increases cell division in certain tissues.
- Essential for reproduction & maintainance of male characteristics, organs & behaviour.
- WHAT ARE THE SYMPTOMS OF TESTOSTERONE DEFICIENCY?
- Low Testosterone levels contribute to:
- General tiredness, weakness, decreased interests.
- Depression, increased moodiness, emotionality, nervousness, light sleep.
- Decreased memory, concentration, & intellectual agility.
- Poor stress tolerance.
- Decreased muscle mass, dropping muscles, increased muscle weakness.
- Increased mid body fat, increased breast size
- Hot flashes ( in 30%, believe it or not!)
- Increases cardiovascular disease with increased blood pressure, decreased elasticity of the arteries, increased cholesterol, triglycerides, & fibrinogen.
- Greater risk of diabetes.
- Decreased libido, with softer erections.
- More sexual complaints & impotency.
- Dry skin & wrinkling.
- HOW DO YOU DECIDE WHO NEEDS TESTOSTERONE HORMONE REPLACEMENT?
- You treat only when there is a reason to treat as with a constellation of the above symptoms together with low hormone levels on blood testing. You treat when there is not a condition contraindicating the use of Test., such as prostate or breast cancer. You treat only after there has been a digital rectal exam of the prostate that is completely normal as far as tenderness, inflammation, nodules, or anything suspicious & after PSA testing has been done & is normal. I do not give testosterone when the PSA is elevated even if cancer has been ruled out. Some Dr's may go ahead & give Test. under these circumstances. Whether or not testosterone contributes to prostate cancer is still a hotly debated topic with conflicting research findings. If you like to read research abstracts & want more detail see http://www.lef.org/protocols/prtcl-130.shtml It is fairly agreed that estradiol (estrogen) contributes to prostate cancer & for more on this see my previous newsletter on the subject
Minimum testing includes a Free & Total PSA, & Free & Total & Percent Free Testosterone. More comprehensive testing includes Serum Estradiol ( to see if an individual is prone to making too much estrogen from his testosterone). Some estrogen is necessary because males who have no receptors for estradiol are infertile & have osteoporosis. We are ideally wanting the Test. in the upper 1/3 of the normal range for a man 25-35, & the mid to low estradiol in the mid to low normal range. Other useful tests are Serum DHEA Sulfate, FSH, LH, Serum Progesterone, & Sex Binding Globulin.
Testosterone should not be used when blood levels are not low--though some body builders & others do--it is unwise & potentially dangerous.
As with all hormone therapy you need to follow up with repeat blood tests a few month after starting to make sure the dosing is correct. Once the correct dose is clarified, once yearly testing should be adequate, being sure to watch the prostate carefully.
WHAT FORMS OF TESTOSTERONE ARE AVAILABLE AND WHAT DOSE?
The oral form is undesirable & hard on your liver, so forget that. The gels & injectables are the forms with which I have the most experience & the forms preferred by the hormone experts I know. There are also patches, Androderm, & Testoderm. There are also sublingual drops. Dosage varies & starting dose depends upon how low you are in the first place. The ready made pharmaceutical brands come in a relatively small dose of 5-10 mg day. The compounded gels can be any dose, but are often a starting dose of 25-50 mg once daily & adjusted accordingly. Injections are usually 100 mg once weekly or 250 mg every 2 weeks. The gels maintain a more steady level of hormone than the injections which are very high at first, then tapering. For those who tend to make alot of estrogen, there are forms of testosterone available in Europe which don't convert to estrogen. Dr Thierry Hertoghe of Brussels, Belgium is one of the world experts on all hormone replacement therapy & best knows the esoteric forms for special circumstances. The gels are best appled where the skin blushes.
WHAT ABOUT PROGESTERONE?
Just as progesterone is antagonistic to estradiol & protective in women, it is also in men. For this reason some Dr's are recommending the use of low doses of natural progesterone cream when using testostereone to help protect against prostate cancer (if a connection is proven) & to to help relieve the symptoms of benign prostatic hypertrophy as it has been anecdotally noted to do so. The literature is yet scant, but research has shown progesterone helps release a tumor supressing gene p53. Progesterone also inhibits 5 alpha reductase which is a contributor to prostate problems.
- WANT TO KNOW MORE?
- Then I suggest the following books listed in my order or preference:
- Maximize Your Vitality & Potency, For Men Over Forty by Jonathan Wright M.D.
- Testosterone Syndrome, The Critical Factor For Energy, Health, & Sexuality- Reversing The Male Menopause by Eugene Shippen, M.D.
- Super T by Karlis Ullis, M.D.
Please stay healthy & Happy.
- If you know anyone who would find this info to be of interest, please forward to them. If the formatiing isn't as you want when you print this news, it will be in the archives on the web site in a few weeks where it will copy better for printing.
"To live fully in Joy & daily Celebration, we must abandon ourselves
- to the dance of existence. Life is a dance, and the dance goes on
- with or without us." ----William Edelen
Priscilla Slagle M.D.
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